Child Abuse Reporting Made Easy

1. Listen to the child. Allow them to talk to you and say whatever they
may need to say. Stay calm and non judgmental.
2. Document what the child discussed with you or what you have
witnessed on the form below. (All information will be needed when
making your report)
3. Call CPS and give your report. Brown County CPS Numbers:
During office hours: 920-448-6000 (Agency Switchboard)
Direct lines to CPS phone workers: 920-448-6035 or 920-448-6036
After hours: 920-448-3200 (Green Bay Police Department, page child
protection)
4. If it is an immediate emergency call 911.
Childs Full Name: _____________________
Date/Time:
_________________
Birth date/Age__________________
Parents/Guardians
Names:________________________________________________________
Childs Address:
_________________________________________________________________
Describe the nature and extent of injuries (if any):
____________________________________
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe any neglect (if any):
______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Any evidence of previous injuries or deprivations? If yes, describe
________________________
______________________________________________________________________________
_____________________________________________________________________________
Identity of the offending adult (if known)
____________________________________________

Any additional information reporter may believe to be helpful in establishing

the cause of injuries or neglect:
______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Reporters Information
Full Name: _______________________________
Professional
title________________
Address: _________________________________
Phone number
(___)_____________